Background
In an Australian first, 47 hospitals came together in 2002 to form a national emergency department collaborative, under the auspices of NICS. The aim was to develop and implement programs that would decrease patients’ wait for treatment — a seemingly Herculean task as the peak-winter period for emergency presentations approached!
Despite the season and the increased pressure the emergency departments were under, their achievements were remarkable. In some cases the steps implemented were as simple as motivating staff, adapting internal procedures or providing early assessment and treatment of pain upon arrival in the emergency department - but they had a significant effect.
The collaborative tackled some of the most important problems in emergency medicine, such as how to reduce the time it takes to give patients with pain appropriate pain killers and how to ensure patients with life-threatening infections are given appropriate antibiotics quickly.
Method
NICS used this program to test the breakthrough collaborative method. This had been used in a Victorian emergency department collaborative in 2001 and is used extensively by the American Institute of Healthcare Improvement in a variety of clinical settings.
The breakthrough collaborative method was chosen as it is known to help the rapid sharing and spread of ideas among participants in pursuit of a common aim.
The breakthrough collaborative model makes use of what are known as plan, do, study, act cycles of activity, underpinned by three improvement questions:
- What are we trying to accomplish?
- What change could be made that might lead to an improvement?
- How will we know that a change is actually an improvement?
Of particular interest to NICS was some of the questions not well understood about the breakthrough collaborative model, such as the sustainability of changes made using this model, its effect on participants, and the cost effectiveness of the model.
What was achieved?
Results can be measured in both overall program terms and in the effects on individual hospitals and participants. To show the impact of participation on individual hospitals we have created a stories from the emergency department collaborative page, where ten vignettes have been chosen to illustrate the creativity and imaginitive thinking of those who took part.
Overall the collaborative made some significant inroads into emergency care. In seeking to reduce the time to analgesia administration there was a 19 per cent improvement overall, which equates to a reduction of 20 minutes in the median time to analgesia across 41 of the 47 participating hospitals.
In reducing the time to thrombolysis, South Australian participants reduced the State average time from 60 minutes to 44 minutes (with 40 per cent of these patients receiving thrombolysis within 40 minutes).
Participating hospitals developed innovative ways to improve other areas of emergency care, such as reducing the time taken to refer patients to specialist care, reduce the time taken to administer antibiotics and reduce the length of stay in the emergency department.
Publications
The Final report of the NICS emergency department collaborative covering the achievements and a summary of the evaluation strategies used is now available. NICS also commissioned the Qualitative evaluation of the NICS emergency department collaborative to identify the key elements for success that can be applied to other evidence implementation projects.
- Final report of the NICS emergency department collaborative (PDF 627KB)
- Qualitative evaluation of the NICS emergency department collaborative (PDF 288KB)
Further information
For more information on this program contact Sue Huckson on (+613) 8866 0410 or email emergencycare@nhmrc.gov.au